Endocrine Abstracts

Patients with Polycystic ovarian Syndrome (PCOS) present to an endocrine clinic with weight gain, hirsutism or period irregularities. Dianette is widely used to treat these problems but can lead to weight gain. Weight loss in PCOS has been shown to improve these clinical features but difficult to achieve. More recently Metformin therapy has been shown to improve period irregularities in PCOS. The role of slimming agents has not been studied previously.

Patients with PCOS in our endocrine clinic who were concerned about their weight were taken off Dianette (if they were on it) and offered treatment with Metformin (500milligrams tds) initially and Sibutramine (10-15milligrams daily) added subsequently. An audit of 26 patients, mean(SD) age 31(8.9), BMI 36.8 (9.02),who have been treated with Metformin(Met) and Sibutramine (Sib)or either agent alone was conducted. 23 patients received Sib and Met (3 of whom had Sib alone as they were unable to tolerate any Met). Patients treated with the combination (n=20) received Met for mean(SD) 12.5(26.6) months and Sib for mean(SD) 4.9( 4.1) months. Patients on combination therapy lost a mean(SD) 4.3kg(6.0) p<0.005, whilst those on Sib alone(n=3) lost mean(SD)11.2kg(10.0), Those on Met alone (n=3) gained mean(SD)1.36kg(7.11) . 3 patients discontinued Sibutramine therapy. For those who continued Sib plus/minus Met(n=20) mean(SD) weight loss was 5.3kg(7.1), p=0.001. 4 of 6 patients with amenorrhea reported having a period whilst patients reporting regular periods increased from 11.5% to 61.5%. 35% of patients who reported hirsutism pretreatment felt that this had improved with therapy.

Conclusions: Sibutramine appears to be an effective agent for weight loss in obese women with PCOS. The combination of Metformin and Sibutramine is tolerated and effective at weight loss and improving menstrual irregularities . Further research will establish the role of these agents as first line agents for the treatment of PCOS.